Policy Challenges Research Articles

9.X.1. Protecting the mental health of healthcare workers: evidence, policy and implementation challenges

Abstract Background There is growing evidence that highlights increasing stress levels and declining mental health among the global healthcare workforce, exacerbated by challenges within workplace environments, labour market and policy frameworks. These conditions place additional strain on an already vulnerable healthcare workforce and consequently threaten the stability of health systems as a whole, given the escalating challenges in retaining, recruiting and reactivating healthcare workers. Although the problems are evident, awareness is increasing and international organisations such as the WHO have advanced policy recommendations, comprehensive and context-specific interventions effectively addressing these problems at varying levels are missing. Objectives This innovative workshop offers a platform for bridging the gap between research evidence and policy interventions, stimulating policy learning and knowledge exchange across countries. The session provides an overview of existing knowledge and engages representatives of academia as well as national policymaking, and international organisations to critically discuss challenges as well as good practice experiences with a focus on implementation and problem-solving. The following major questions will be explored: What evidence is available regarding the mental health and wellbeing needs of the healthcare workforce? How are different countries responding to these needs and supporting healthcare workers more effectively? What are some best practice cases focusing on improving mental health support for healthcare workers across various groups, considering diverse needs, gender-inclusiveness, and minority groups? Finally, how can evidence-based policymaking be improved, and how can the implementation of these policies be advanced in a more effective manner? Thesession will encourage critical debate and identify major policy recommendations, focusing on governance and implementation strategies. In the second half of the session, the panel will engage the audience in an interactive discussion to explore novel solutions that prioritise the wellbeing of healthcare workers and effectively address the healthcare workforce crisis in a more person-centred and ‘humanised’ manner. The workshop supports cross-country learning and networking opportunities. Key messages • Mental health and wellbeing of the healthcare workforce is crucial for health system resilience and needs stronger advocacy for coordinated multi-level governance action. • Establish a health system and governance approach together with comprehensive monitoring and qualitative comparative workforce studies to identify transformational policies in contextual settings.

2.A. Practice session: Policy labs: getting public health research into policy and practice

Abstract The process of translating health research into policy and practice benefits is often too slow, taking an average of 17 years globally. Additionally, health policy changes fail when they have an inadequate understanding of the communities and challenges they seek to address. The Policy Institute at King’s College London has developed an innovative ‘Policy Lab’ method, which convenes diverse policy and practice stakeholders such as health workers, patients and policymakers, to discuss a policy challenge, assess the evidence and co-produce viable policy options. The proposed workshop introduces this method in a practical, impactful session aimed at helping participants from any country and research background mobilise their research to improve health outcomes. Policy Labs have been shown to be highly successful method. Previous Policy Lab outcomes include influencing changes to the Mental Health Act in the UK, new international guidance on treatment of type 2 diabetes, and a global coalition on paying for prevention in dentistry. The method can be adapted to different health challenges and considers the potential for change in local, national and international arenas. The workshop teaches this method in a way that enables researchers to apply it to their own work, harnessing the potential of research to improve health outcomes. Objectives of the workshop The workshop aims to teach people the skills to design and run a Policy Lab so that they can better mobilise their research into policy and practice. Participants will learn To develop policy-relevant questions from their research; Stakeholder mapping; To design a policy lab agenda; To develop a research engagement plan. What is the added value of the workshop? The workshop teaches an innovative method that helps researchers greatly increase the policy impact from their work. It provides attendees with practical tools to employ in their own work and bridge gaps between their research and policy and practice changes. The format of the workshop will involve a short presentation on Policy Labs by facilitators, followed by four brief interactive activities for participants, as follows: Facilitator presentation: (10 mins) Introducing the Policy Lab method; Group work 1: (10 mins) Developing a policy-relevant question; Group work 2: (10 mins) Stakeholder mapping; Group work 3: (10 mins) Designing a lab agenda; Group work 4: (10 mins) Developing a research engagement plan. We have allowed 10 minutes to adapt to any arising demands, as well as to bring the session to a close with some key messages. Participants will be guided by the facilitators, and we will use template handouts for participants to complete during the session to reinforce learning. The handouts also ensure that those who wish to work independently rather than in groups may do so if preferred, and will provide participants with the practical tools necessary should be they arrive late or need to leave early. Key messages • Policy Labs are an effective way for researchers to have policy and practice impact with their work. • Participants will learn how to run a successful Policy Lab, and improve their research impact.

Problematizing street vending: The uncanniness of a disembodied urban policy

ABSTRACT Street vending is an important source of livelihood for many urban dwellers in Africa but remains a challenge for urban policy and planning. This paper uses Ghana as a case study to examine how street vending is treated in urban policy frameworks. We use qualitative content analysis to critically review four major urban policies that shape the planning, development, and management of Ghanaian cities. Our findings reveal a misalignment of local urban policies with national policy on the regulation of street vending. The regulation of street vending is unclear, contradictory, and ineffective, failing to provide a clear policy direction and adequate planning tools for integrating street vending into urban spaces. We argue that these policy inconsistencies persist due to power imbalances and governance challenges, with local authorities maintaining ambiguous policies that benefit powerful stakeholders while keeping street vendors in a state of insecurity. We call for more coherent and inclusive policies that recognize the socioeconomic value of street vending and foster more inclusive urban spaces. We also highlight the need for reformed urban governance that empowers marginalized voices and builds cross-scale alliances to address the complexities of urban informality and support the informal economy.

Colorectal cancer research priorities in Uganda: perspectives from local key experts and stakeholders.

The incidence of colorectal cancer (CRC) is increasing in Uganda but there is limited local research to guide policy and programming for CRC prevention and control. A stakeholder engagement workshop took place in Kampala on 19March 2024 to identify challenges and opportunities for CRC prevention and control in Uganda. A total of 30 stakeholders with expertise in CRC primary and secondary prevention, diagnosis, treatment, palliative care as well as cancer survivors participated in the workshop. Key challenges for primary prevention included low knowledge/awareness of CRC among the general population and health workers, and rising prevalence of CRC related risk factors. Limited CRC screening, diagnostic facilities and specialists were identified as barriers to diagnosis. Treatment related challenges included limited accessibility to surgical services and drugs, late-stage presentation leading to poor treatment response, treatment abandonment and drug related toxicity. Lack of universal health coverage policies, limited community-based cancer awareness programs, and lack of national cancer registries were cited as policy and economics challenges. Opportunities to address these challenges were discussed. Our findings highlight areas for further research and prioritization to address Uganda's growing CRC burden and may be applicable to other low-resource settings.

Commercialisation, exogenous shocks and nutrition: Evidence from smallholder farmers in Bangladesh

AbstractThis study empirically analyses the effect of agricultural commercialisation on food spending and nutrition outcomes in Bangladesh. We examine whether exposure to exogenous climate shocks moderates these relationships. We construct individual‐level nutrition measures and time‐varying climate extremes using nationally representative panel data. To address endogeneity concerns, we use an instrument variable approach. Results show that commercialisation leads to an improvement in the broad nutritional profile of individuals. However, the commercialisation–nutrition linkage is weaker for households exposed to frequent climate shocks than those in climate‐resilient areas. Importantly, climate shocks dampen the positive nutritional impacts of commercialisation and exacerbate existing inequalities in the nutritional status within the households. Women and girls appear disproportionately vulnerable to the nutrition‐weakening effects of weather stresses in commercialised agricultural households. This highlights twin policy challenges: strengthening smallholders' resilience to escalating climate risks alongside promoting gender‐equitable, nutrition‐sensitive agricultural commercialisation.

Los instrumentos integradores en los sistemas de cuidados en América Latina: una visión de política pública

Some Latin American governments have developed systems that seek to comprehensively guarantee the right to provide and receive care. These initiatives aim to recognize, redistribute, or reduce caregiving work within households by coordinating a set of policies, implemented by different agencies, around the same individual. Achieving this requires overcoming the challenge of intersectoral coordination, based on management instruments that allow interventions to be articulated around the diverse care needs of the population. Based on the policy integration literature, we conduct a comparative analysis of four emblematic care systems in the region using official data and semi structured interviews. In contrast to recent research that analyzes programs, services, and target populations, we focus on how systems manage to operate in a coordinated manner. We argue that building care systems requires the construction of instruments that ensure the integrated operation of the system around a person or territory. We examine how the deployment of specific decisions to guide the operation of care systems address a key contemporary challenge in public policy and administration: the coordinated operation of policy sectors around complex problems and the construction of comprehensive responses to multidimensional challenges.

An effective approach to tackling complex health policy challenges. Using a clinical microsystems approach and rethinking codesign.

That people with serious mental illness have poor physical health and face a significant life expectancy gap compared with the general population is well known. Despite considerable policy focus in some countries, the gap in life expectancy remains. Tackling complex and persistent health problems such as this requires a systems-based approach, recognising the complexity of interacting components and their effects on the problem and on each other and applying collaborative analysis, design and implementation by those with knowledge of and expertise in the problem and the context. This paper describes the methods used to develop the Australian Being Equally Well National Policy Roadmap for better physical health care and longer lives for people with severe mental illness. Whilst recognising that high rates of physical health comorbidities are caused by many factors including lifestyle, access to high-quality healthcare and medication side effects, the work was focused on what could be done within Australian primary care to improve the physical health of this cohort. A Clinical Microsystem Approach was applied to synthesise clinical evidence with professional and lived experience, and an innovative policy development process was established, creating trust across all system levels. Participants with different kinds of knowledge and experience worked in discrete groups according to their professional or expert role whilst also being supported to participate in an intensive cross-collaboration. The potential value of this methodology for tackling other complex problems in health policy is discussed.

How workable is a 20-minute city in Australia? Re-examining the challenge of change in spatial labour and job relations

ABSTRACT Most x-minute city studies focus on liveability and neighborhood accessibility to local services, but rarely include primary employment. This paper complements these studies by examining the urban employment structure and transport dynamics of an Australian city under the 20-minute city concept framework. To do this, we develop a comprehensive method to model residents’ job access time using census-based journey to work (JTW) data and detailed household activity and travel survey. Analysing JTW time stepping down to diverse industry and employment categories and transport modes allows new insight into the disparity in residents’ job and housing locations and transport choices at local scales. By evaluating the distribution of working residents, types of employment, and transport performance, this paper examines possible policy responses and challenges of change in expanding the 20-minute planning target for employment. The analysis suggests that housing infill development could support reduced JTW time for residents experiencing longer time for work travels. However, this would require active planning of both land-use mix and dwelling design to meet prevalent household expectations about dwelling size and quality.

Overcoming barriers to proactive plastic recycling toward a sustainable future

The plastics sector, accounting for a significant portion of global emissions, presents a challenge and an opportunity in achieving carbon neutrality. Despite Japan's commendable polyethylene terephthalate (PET) bottle recycling rates, most plastics are thermally recycled, creating environmental issues. This study proposes an evaluation framework to enhance recycling, aligned with end-user preferences and fostering a circular plastics economy. Employing a mixed-methods approach, this study conducts fieldwork including interviews with plastic recyclers and analysis of industry data. A weighted sum multicriteria analysis integrating end-user preferences, recycling effectiveness, and market dynamics is utilized. Systemic, process, and policy challenges were shown to hinder sustainable recycling practices, while varying willingness to pay, emission and cost reduction potentials, among acceptability and sectoral diversity informed priority plastic types for recycling. Multicriteria analysis showed that although PET is favored by end users, Polyoxymethylene (POM) emerges as a potential priority target for manufacturers and recyclers. Sensitivity analysis underscores the potential impact of establishing or enhancing willingness to pay (WTP) toward certain plastic types. Moreover, manufacturer and recycler evaluations suggest a broader willingness to recycle plastics than previously assumed. The proposed evaluation framework offers insights toward plastic recycling strategies. Policy interventions such as sustained subsidies for recyclers, market incentives leveraging WTP preferences, and technological advances, including chemical recycling and the broadening of plastic type recycling in line with user and manufacturer preferences, could all contribute to promoting sustainable plastic recycling practices.

An overlooked market: loose cigarettes, informal vendors and their implications for tobacco taxation

ObjectiveTo examine the features of markets for loose cigarettes in several low-income and middle-income countries and their effects on tobacco control policies, particularly taxation.DesignAn analysis of survey data targeting people...

Sustainable development in African countries: evidence from the impacts of education and poverty ratio

This paper uses the autoregressive-distributed lag model to investigate the effects of education, poverty, trade volume, ICT development, and GDP per capita on sustainability in the 15 largest African economies from 1999 to 2019. The results show a positive correlation between higher tertiary education rates and sustainability, emphasizing the importance of investing in education for sustainable development. In contrast, higher poverty rates are linked to lower sustainability, highlighting the need for poverty reduction efforts. Increased trade volumes are associated with reduced sustainability, indicating the challenges of trade liberalization policies in achieving sustainability goals. However, ICT development has a significant positive impact on sustainability. Interestingly, higher GDP per capita is linked to lower sustainability, potentially due to unsustainable consumption patterns and social inequalities. Policy recommendations for promoting sustainable development in African countries include targeted measures focusing on education and poverty reduction. Gender-friendly policies and initiatives to eliminate educational disparities, especially among marginalized groups, can enhance human capital development. Additionally, promoting e-businesses and sustainable entrepreneurship, along with attracting foreign investment for sustainable education and employment initiatives, can drive economic growth while minimizing environmental impact and fostering inclusive development.

Priorities and challenges in social and healthcare policies for older people living in the Mediterranean basin: A Delphi panel study

BackgroundRecently, the countries in the Mediterranean basin (which share cultural ties) have been showing a common trend of declining social support for the elderly, with deficiencies in social care models for this demographic. Thus, this Delphi panel study analyzed the gaps in social and integrated care among the participating countries in a European research project.MethodsThis three-round Delphi panel study focused on the European countries of Greece and Spain and the non-European countries of Egypt, Lebanon, and Tunisia. In this project, experts were identified according to their level of expertise in the subject matter, their gender, and their membership in different social groups. Subsequently, they were asked to identify the current situation of social care, set future goals, and locate the gaps regarding the social and healthcare models for older people in the participating countries. The median score (Mdn) and interquartile range (IQR) were calculated to assess the degree of consensus on the different priorities.ResultsAmong the participating countries, there was a lack of state agreements to maintain social care models, a lack of coordination between public and private institutions to provide social care services, territorial inequalities in terms of access and coverage of rights, and job insecurity for professionals. The desired situation was to integrate social and healthcare services with a person-centered social care model, thus promoting autonomy and empowering users and families in participation and decision-making.ConclusionsThis Delphi study reveals significant disparities in social and healthcare policies for older adults across Mediterranean countries, highlighting shared challenges and specific national needs. European nations like Greece and Spain face fragmented systems, while non-European countries such as Lebanon, Egypt, and Tunisia lack specialized geriatric services and social security. All countries urgently need better professional training, social and economic empowerment of older adults, and integrated national strategies. These findings offer key insights for policymakers to develop equitable, sustainable solutions for aging populations.

Exploring Nigeria’s waste-to-energy potential: a sustainable solution for electricity generation

Abstract This research explored the potential of waste-to-energy (WtE) technology as a sustainable solution to Nigeria’s energy deficit and waste management challenges. Various WtE technologies were reviewed, including incineration, anaerobic digestion, gasification, and pyrolysis, highlighting their applicability and benefits for Nigeria. The potential energy yield from different waste streams, combined with economic viability, environmental benefits, and social impacts, demonstrates the importance of WtE technology for the country. The lower heating value of municipal solid waste and agricultural residue significantly affects energy yield. The incineration of 27.36 million tons of organic waste annually while using relevant technology with energy recovery could generate between 14.52 and 23.08 TWh of electricity per annum. The inclusion of paper and textiles increases the potential yield to 18.69 and 29.71 TWh per year. The potential power generation from agricultural residues is estimated at 80.3 GW. However, Nigeria must address technical, economic, and policy challenges to realize this potential. This can be achieved by developing a robust regulatory framework, fostering public–private partnerships, enhancing local capacity, engaging communities, and investing in research and development. The implementation of WtE projects will facilitate sustainable waste management, improve energy security, create jobs, and promote environmental stewardship.

Uncovering the universe of New Psychoactive Substances (NPS): Understanding the mechanisms of action and adverse effects in an accessible and didactic way

New Psychoactive Substances (NPS) constitute a heterogeneous group of drugs associated with a range of health harms, producing more intense effects than traditional drugs. NPS pose a challenge for public health policies due to the limited information available about their effects on the body. Understanding the primary effects of NPS and their mechanisms of action is crucial for guiding healthcare professionals and raising awareness about the dangers associated with their use. In this context, the aim of this study was to gather the most current scientific information on the mechanisms of action and adverse effects of NPS, transforming it into a simple and accessible educational material for the public. Based on the information collected in this review, it was possible to develop a playful educational tool that not only informs about the effects of NPS but also provides clear information about the mechanisms of action of these substances in the CNS, as currently known for the wide variety of NPS. By making this information accessible and understandable, the booklet contributes to public awareness and empowers individuals to make informed and responsible decisions about the use of psychoactive substances. Additionally, it serves as a valuable educational tool for healthcare professionals and educators.

Serious Game Development for Public Health: Participatory Design Approach to COVID-19 Quarantine Policy Education.

Public health education plays a crucial role in effectively addressing infectious diseases such as COVID-19. However, existing educational materials often provide only foundational information, and traditional group education faces challenges due to social distancing policies. Addressing these gaps, our study introduces a serious game called "Flattening the Curve." This interactive experience immerses learners in the role of quarantine policy managers, offering unique insights into the effects and challenges of social distancing policies. The development of the game adhered to the SERES framework, ensuring a scientifically designed foundation. To achieve its learning objectives, the game incorporated learning and game mechanics including an agent-based infection model, a social distancing policy model, and an economic model, which were developed based on previous literature. After defining a broad concept of scientific and design foundations, we used a participatory design process. This study included 16 undergraduates and took place over one semester. Participants played the game, gave feedback, and answered surveys. The game was improved based on participants' feedback throughout the process. Participants' feedback was analyzed based on the Design, Play, and Experience framework. Surveys were conducted before and after the activity and analyzed to assess participants' evaluation of and satisfaction with the game. The game successfully achieved its learning objectives, encompassing a comprehensive understanding of infectious disease characteristics; the disease transmission process; the necessity and efficacy of quarantine policies and their delicate balance with economic factors; and the concept of flattening the curve. To achieve this, the game includes the following: (1) an agent-based infection model based on the modified Susceptible-Exposed-Infectious-Hospitalized-Recovered (SEIHR) model with five infectious disease scenarios; (2) a quarantine policy model with social distancing, travel control, and intensive care unit management; and (3) an economic model that allows users to consider the impact of quarantine policies on a community's economy. In response to participatory design feedback, the game underwent meticulous modifications, including refining game systems, parameters, design elements, the user interface, and interactions. Key feedback included requests for more scenarios and engaging yet simple game elements, as well as suggestions for improving the scoring system and design features. Notably, concerns about the fairness of the outcome evaluation system (star rating system), which could incentivize prioritizing economic activity over minimizing casualties, were raised and addressed by replacing the star rating system with a progress-based vaccine development system. Quantitative evaluation results reflect participants' positive assessments of the game through the learner-centric approach. The serious game "Flattening the Curve," developed through a participatory design approach, emerges as a valuable tool for public health education, particularly concerning social distancing policies. The game and its source code are openly accessible online, enabling widespread use for research and educational purposes.

서비스산업 육성을 위한 정책추진의 성과와 한계, 그리고 전략적 접근 방향 모색

This study aims to identify the achievements, limitations, and future challenges of service industry policies implemented between 2000 and 2024, and to explore effective policy directions for fostering the service industry. Since the 2000s, the government, which had primarily focused on manufacturing-centric industrial policies, has recognized the service industry as another key pillar for the continued growth of our economy and has consistently made policy efforts to support its development. As a result, while the transition to a service-based economy and the high value-added nature of the service industry have not progressed rapidly, some improvements have been made. However, our service industry is still largely driven by numerous small and low-value-added businesses, and there is a need to expand the industrial foundation that will drive innovation. In addition, with the changing industrial environment, such as advances in digital technology, it is also necessary to enhance the potential capabilities that will shape the future of the service industry. To effectively promote the transition to a service-based economy, two approaches can be considered. One is to identify the issues raised during the service industry's growth and develop solutions. Strategies could include establishing a policy support system, exploring policies that reflect the characteristics of the service industry, and fostering a shift in perception toward the industry. The other approach involves identifying the potential capabilities that will drive the future of the service industry and supporting the foundation to enhance these capabilities. Examples of related tasks include supporting networking among participants, enhancing capabilities needed for developing new business models, and creating a service provision environment to ensure these models take root in the market.

Policy Text AI Mining Study —— A Comparative Analysis Based on U.S., U.K., and Chinese Policies

Artificial Intelligence (AI) has become a key strategic area to enhance national competitiveness globally. We adopts a textual analysis methodology, based on the three-dimensional framework of policy tools and the LDA thematic model, to conduct a systematic analysis and comparative study of the AI policy texts of the United States, the United Kingdom, and China. The study aims to reveal the policy stance, strategic planning, and challenges and opportunities faced by the three countries in the field of AI. Through the analysis, the study identifies the major themes in the policy texts of each country and maps them to the three dimensions of supply, demand, and environment of policy tools. The study finds that the US AI policy focuses on international cooperation, fair civil rights, and innovation ecology; the UK emphasizes ethical governance and legal regulation; and China highlights innovation-driven and smart economy development. In addition, all three countries emphasize building a stable, predictable and innovation-supportive policy environment. The study puts forward a series of comprehensive recommendations, including strengthening international cooperation, balancing innovation and regulation, optimizing a supportive innovation ecosystem, improving the legal system, focusing on talent cultivation, and building an AI innovation alliance. These recommendations aim to promote the healthy development of global AI technologies and maximize their positive contributions to the economy and society.

Adapting to climate change: the ultimate challenge for the next half-century of local government?

ABSTRACT Climate change will have a disproportionate and asymmetric impact on cities and urban areas, and some of their most vulnerable residents will be at particular risk. Studies have found that some municipalities have done far more to adapt to it than others, but there has been a general lack of funding, implementation and engagement with marginalised groups to help them prepare. We suggest that the unpredictable and evolving nature of climate impacts means that adaptation represents a defining public policy challenge for local governments in the coming decades. We set out the broad epistemological, practical and justice issues that this challenge presents for the practice and study of local government, and argue that addressing it will require new approaches that go beyond discrete and familiar solutions.

Evaluating Policy and Legal Challenges in the Legalisation of Artisanal Small Scale Gold Mining in West Kalimantan

Evaluating Policy and Legal Challenges in the Legalisation of Artisanal Small Scale Gold Mining in West Kalimantan

Navigating new norms: Addiction specialists' perspectives on opioid use disorder treatments and policy challenges in the fentanyl era.

Amidst increasing opioid-related overdoses in the USA, opioid use disorder (OUD) treatment has seen few novel treatments emerge. High-potency synthetic opioids (HPSOs) have altered clinical approaches, prompting evaluation of existing medications for opioid use disorder (MOUD) and interest in slow-release oral morphine (SROM) as another therapeutic option. Here we survey addiction specialists on the influence of HPSOs on clinical practice, views on current MOUD regulations, and openness to novel therapies such as SROM. Anonymous, online survey conducted at a national conference of addiction specialists (N = 91). Pearson χ2 tests and Fisher's exact tests to compare respondent characteristics. Approximately 89% of respondents (N = 91) acknowledge that HPSOs shifted addiction treatment in recent years, with 86% modifying their MOUD prescribing accordingly. Moreover, 84% report having patients who could benefit from other full opioid agonists beyond methadone for OUD management. Many report off-label prescribing of full agonist opioids other than methadone for withdrawal symptoms or initiating MOUD. Eighty percent reported being in favor of incorporating SROM as a third-line monotherapy for OUD. This sample of addiction specialists supports innovative alternatives for MOUD in the USA to combat the challenges posed by fentanyl and related HPSOs. Future work should further addiction specialists' opinions on barriers to OUD treatment and exploration of these international strategies in the USA. This appears to be the first study exploring addiction specialists' perspectives on regulatory barriers to OUD treatment and their willingness to uptake internationally adopted strategies such as SROM.